Book Your Skincare Consultation
Schedule an appointment and tell us about your skincare goals.
Full Name
*
First Name
Last Name
Email Address
example@example.com
WhatsApp / Phone
*
Please enter a valid phone number.
Format: (237) 000-000-000.
Preferred Appointment Date and Time
*
Age Range
Under 18
18 - 24
25 - 34
35 - 44
45+
Gender
Female
Male
Location
Region/City
SKIN TYPE & CONCERNS
Tell us what your skin is like naturally and what you'd like to improve
Oily
Dry
Combination
Normal
Sensitive
Not Sure
Main Skin Concerns (select all that apply)
Acne / Breakouts
dark spots / hyperpigmentation
dullness / Uneven tone
Wrinkles / fine lines
Large pores
redbess / Irritation
dark circles
Uneven Texture
excess Oil / Shine
Dehydration
Any other concerns? 9optional)
Describe anything else about your skin.
How would you describe your current routine?
No routine yet
Minimal (1-2steps)
Basic 9cleanser, moisturizer, SPF)
Moderate (serums + treatment)
extensive (multiple steps)
Products currently using
e.g CeraVe cleanser, a vitamin c serum...
Allergies or Sensitivities
Fragrance
Alcohol
Retinol
Vitamin C
Niacinamide
Other
Other allergies or Reactions?
e.g i breakout from Dr Rashel Vitamin c serum
What is your budget range for your skincare routine?
Under 25,000 XAF
25,000 – 50,000 XAF
50,000 – 75,000 XAF
75,000 – 100,000 XAF
100,000+ XAF
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